Organization
UNIVERSITY OF UTAH PLASTIC SURGERY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELL I MADONNA (DIRECTOR OF CONTRACTING AND PE)
(801) 587-6464
Entity
Organization
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
PO BOX 58049, SALT LAKE CITY, UT 84158-0049
(801) 581-7073
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Enumeration date
08/07/2006
Last updated
04/14/2009
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